When she is travelling in the developing world, Sue Desmond-Hellmann, a world-renowned oncologist and chief executive of the $40bn Bill & Melinda Gates Foundation, is often mistaken for a secretary.
She finds it funny rather than offensive. “They’ll look for the chief executive of the Gates Foundation . . . and not look for a woman,” she laughs, when we meet at the foundation’s somewhat soulless London outpost, a stone’s throw from Buckingham Palace.
A thick skin is useful in her current role managing the distribution of wealth built up by Bill Gates after he co-founded Microsoft more than 40 years ago. Leading the Gates Foundation involves thinking strategically over a decades-long span while at the same time dealing with a more day-to-day flow of controversies that come with its position as a leading exponent of “Big Philanthropy”.
When she took the job in 2014, she became its second female head — Patty Stonesifer stood down in 2008 after 10 years — but the first non-Microsoft executive to land the top job. Instead, her previous role was in academia, where she spent five years as the first female chancellor of the University of California, San Francisco
In her current job, on a salary of just under $1m a year (including benefits), she is in charge of 1,400 people around the world, and responsible for dispersing approximately $4bn a year to causes that range from the eradication of malaria — perhaps the Gates Foundation’s most high-profile campaign — to investing in education in the US.
The brief is extraordinarily varied, not least in the task of managing such a global organisation, spanning offices from Beijing to Addis Ababa.
But then Dr Desmond-Hellmann is used to working across cultures. She trained as an oncologist, and spent several years practising medicine before moving with her husband, Nicholas Hellmann, an infectious diseases specialist, to Uganda at the height of the Aids epidemic in 1989.
In Uganda, 10 years after the fall of former dictator Idi Amin, the clash, as she and her husband soon found, was not so much cultural as physical. They had to adapt, at times, to living without electricity and water.
“We had just gotten married,” she explains. “It was a very difficult time for Uganda, and it was so profound to recognise — more than I had ever recognised in the past — what people call privilege. That all the learning I had done [to become a doctor], all that fierce studying, didn’t matter at all if I didn’t make a contribution.”
Initially, Dr Desmond-Hellmann had been attracted by the scientific challenge. Kaposi’s Sarcoma, a cancer common in patients with advanced Aids-related illnesses, had been observed in Uganda before the epidemic in the west. “I thought I would go there and learn something and hopefully make a contribution,” she says.
The move was the making of her as a manager.
“I worked with my husband, who is more introverted, and he ran the laboratory. We had 35 Ugandan employees, and while we didn’t have an overt discussion, I did the hiring and firing and the management — and discovered how much I enjoyed leading at the time. It was such an eye-opening experience in every way.”
Dr Desmond-Hellmann was born in Napa, California, one of seven children. She attended Catholic elementary and high schools, but she is keen to stress her religious beliefs do not inform her professional life. “I’m very much a separation of church and state kind of gal,” she laughs.
This is an important distinction for her to emphasise, particularly within a charitable organisation that promotes access to contraception and family planning. The issue of how to approach female reproductive health in the developing world has been sensitive already.
Two years ago, Melinda Gates, a practising Catholic, wrote in a blog post that she had struggled with the issue of abortion. “But I’ve decided not to engage on it publicly,” she wrote, “and the Gates Foundation has decided not to fund abortion.” Ms Gates later told Christianity Today that she is “living out [her] faith in action”.
It proved a controversial decision, leading to accusations from some quarters that the foundation was “stigmatising abortion” — something Dr Desmond-Hellmann is quick to dismiss.
“The foundation has made a decision that we’re not going to take a stance on abortion,” she says. “We’re going to support contraception, which we think is really important, but abortion is a very heated and polarising discussion. I’m very comfortable with the leadership that Melinda has provided for the foundation on this.
“When you are part of a family,” she adds, “then the family gets to make choices of how the Gates Foundation goes, and I’m really comfortable with that.”
Here lies one of the main criticisms not just of the Gates Foundation, but of many of the larger philanthropic institutions: that they exist to serve the whims of the founders rather than the general public. Then there is the wider question of how philanthropists are seen in the modern world.
“People don’t like it when billionaires tell them how their kids should be educated,” says Michael Edwards, an editor for the openDemocracy website and author of Small Change: Why Business Won’t Save the World, on the foundation’s advocacy of US high school reform.
Accountability is another concern. To whom do these multibillion-dollar foundations answer?
For once, Dr Desmond-Hellmann’s confident responses falter. In reply to a suggestion that transparency is not the same thing as accountability — putting everything online means you can see what the foundation is doing, but does not mean that it is being held to account — she seems uncharacteristically stuck for words.
“The way that people can hold us accountable is to look at what we achieved as a foundation through our collaborations,” she says, quickly regaining her poise.
She accepts that there will always be critics, but rejects those who just offer a blanket “no” when the foundation is attempting to innovate — and when it does not itself know what the outcome of its experimentation will be.
Instead of having its attempts prejudged by others, she feels it should be allowed to “get a crisp answer” by testing hypotheses. “That, I think, is good,” she adds.
One undoubted positive attribute of the foundation is the ability to think long term. While it will be wound up 20 years after the deaths of its founders, that still provides a time horizon of about 50 years, she says.
“A government may need to be responsive to their citizens more quickly,” she explains. “But we can take a 10-year bet, we can take a 20-year bet because we don’t need to answer to citizens or shareholders. We try to focus on long-term bets and taking risks that others can’t.”
Criticism of what is happening in the present is welcome, she adds, but a philanthropic organisation of this scale and ambition needs always to look to the future.
“For example, we’re trying to invest in the science of vaccination that might not pay off for 20 years,” Dr Desmond-Hellmann says. “But who is going to invest in vaccination at the deep level if not the Gates Foundation?”
